Mohamed Ruzaik Ibrahim, MD
Individual provider Active NPI Cardiovascular Disease Physician · Mount Vernon, IL
NPI 1235309527 · NPPES record last updated Jun 30, 2016
Key facts
- NPI
- 1235309527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 036128960 (IL)
- Practice address
- 4115 S Water Tower PL
Mount Vernon, IL 62864-6293 - Phone
- (618) 315-6090
- NPI assigned
- Mar 3, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- University of California, Geffen School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Massena Hospital Inc
Canton-Potsdam Hospital
Practice addresses (Care Compare)
1 Hospital Dr
Massena, NY 13662-1056
201 Market St
Suite E
Potsdam, NY 13676-1218
Phone (315) 274-9102
Hospital & facility affiliations
- Canton-Potsdam Hospital
- SLHS Massena, Inc
- Gouverneur Hospital
- The University of Vermont Health Network-Alice Hy
- Clifton-Fine Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 98.56 of 100
- Quality
- 87.76
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 98.56 of 100
- Quality
- 87.76
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220819002352 | NY | Practitioner - Cardiovascular Disease (Cardiology) | 4082786942 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 98494 | CA | MD | Clinical Social Worker |
| A98494 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massena Hospital, Inc | Current |
Accepting new patients | |
| Massena Hospital Inc | Current |
Accepting new patients | |
| Canton-Potsdam Hospital | Current |
Accepting new patients | |
| Canton-Potsdam Hospital | Current |
Accepting new patients | |
| Southern Illinois Heart and Vascular Center, PC | Cardiovascular Disease | Past |
Accepting new patients |
| Canton Potsdam Hospital | Past | Accepting new patients |
Locations
1 Hospital Dr
Fl 3
Massena, NY 13662
Phone (315) 769-1111
1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711
50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034
201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JBDGCA
- ribrahim352016@direct.rochesterregional.org
- mribrahi@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A98494 | CA | |
| Cardiovascular Disease Physician | 207RC0000X | 036128960 | IL | Yes |
Addresses
Primary practice location
4115 S Water Tower PL
Mount Vernon, IL 62864-6293
Mailing address
4113 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone (618) 315-6090
Other providers in Mount Vernon, IL
- Brian Scott Hughes
- Sarah E Hughey
- Mark C. Hurst
- Hutchison Enterprises LLC
- Hutchison Medical, Inc.
- Gloria Funbi Igboin
- Trevor Ile
- Jane Iles
- Illinois Express Vision Center, Mattoon Inc
- Indiana Hearing LLC
All providers in Mount Vernon, IL · Cardiovascular Disease Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.